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尿毒症常见病因课件_1

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尿毒症常见病因课件 尿毒症常见病因PPT 尿毒症常见病因 尿毒症ppt课件 尿毒症PPT
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湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 尿毒症的常见病因 湛江中心医院肾内科 曾蕾 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 常见病因有: 1、肾小球病变; 2、 肾小管间质病 变; 3、肾血管病变; 4、遗传性肾病。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 1、肾小球病变 分为原发性与继发性肾小球肾炎。 原发性肾小球肾炎常见有IgA肾病、局灶节段 性肾小球硬化症等,是一个慢性病变迁延不愈过 程,较为隐匿,早期临床症状多为乏力、纳差, 绝多数患者不引起重视,以为是身体劳累、休息 不好所致,往往找一些中药或者一些偏方吃一段 时间,很容易错过治疗最佳时间,到症状很明显 再来医院时已经到了不可逆的尿毒症期了,为时 已晚! 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 继发性肾小球病变 常见狼疮性肾炎、糖尿病肾病、高 血压肾病等等。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 系统性红斑狼疮 本病在我 国的患病率为1/1000,高于西 方国家报道的1/2000,以女性 多见,尤其是20-40岁的育龄女 性。我国南方的发病率远远高 于北方,在我们粤西地区这是 一个很常见的疾病。狼疮是一 种全身性免疫疾病,35%-90% 累及肾脏,病情凶猛,且预后 欠佳,部分患者控制不良可以 发展成尿毒症,终末期狼疮肾 炎患者除了维持性血液透析, 还需长期服用糖皮质激素或细 胞毒素类药物。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 狼疮引起全身多 脏器损伤: 除了皮肤、关 节损害,还有狼 疮肾病、狼疮脑 病、狼疮肺炎、 狼疮心包炎等等 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 糖尿病肾病 在西方发达国家,糖尿病肾病是尿毒症患者 最主要原因,而我国糖尿病肾病患者在尿毒症患 者中的比例逐步升高! 糖尿病肾病是糖尿病微血管并发症之一,是糖 尿病患者的重要死亡原因。随着糖尿病治疗的不 断改进,死于糖尿病急性并发症者已大为减少, 患者的生命明显地延长,然而糖尿病的各种慢性 并发症,包括糖尿病肾病的发生率却明显增高。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 糖尿病肾病临床表 现: 1. 肾小球滤过率增高 为最早出现的功能 性改变,表现为尿 频、尿多、夜尿增 多。 2. 蛋白尿 蛋白尿是 糖尿病肾病最主要 的表现。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 3. 肾病综合征 约 10%糖尿病肾病在 病程的某一阶段表 现为肾病综合征, 尿蛋白3g/24h,血 清白蛋白降低,浮 肿,高胆固醇血症 。多数患者在较短 期内进人肾功能不 全,预后不良。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 4. 高血压 明显高血压 是糖尿病肾病 晚期的表现。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 5. 肾功能不全 临床糖尿病肾病多发生 在糖尿病病程15年之后,一旦出现明 显蛋白尿,肾小球滤过率就逐步而恒 定地下降,平均每月下降约lml/min。5 -20年后进入终末期肾功能不全。年轻 患者多死于尿毒症。老年患者主要死 于冠心病,心肌梗塞,死于尿毒症者 只占1/4左右。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 糖尿病肾病治疗: 1. 严格控制血糖 在出 现临床糖尿病肾病之 前,也就是在糖尿病 早期,用胰岛素泵或 多次皮下注射胰岛素 严格控制糖尿病,使 血糖保持基本正常, 可以延缓甚至防止糖 尿病肾病的发生和发 展。对其他并发症也 有益处。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 2. 控制高血压 高血压会促进肾功能衰竭的发展, 糖尿病患者的血压≥130/80mmHg就应 该用降压药,应控制130/80mmHg以 下。血管紧张素转换酶抑制剂或血管 紧张素Ⅱ受体拮抗剂可作为首选药物 ,常需要联合其他降压药。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 3. 限制蛋白质摄入 适当减少饮食中蛋 白质量(0.8/kg·d)可以减低肾小球内 压力,减轻高滤过和减少蛋白尿。相 反,给高蛋白饮食会加重肾小球组织 学病变。 4. 透析治疗和肾移植 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 高血压肾病: 高血压肾病系原发性高血压引起的良性小动脉肾硬化 (又称高血压肾小动脉硬化)和恶性小动脉肾硬化并伴有 相应临床表现的疾病,高血压及肾功能衰竭。 年龄多在40~50 岁以上,高血压病史5~10年以上 。早期仅有夜尿增多,继之出现蛋白尿,个别病例可因毛 细血管破裂而发生短暂性肉眼血尿,但不伴明显腰痛。常 合并动脉硬化性视网膜病变、左心室肥厚、冠心病、心力 衰竭、脑动脉硬化和(或)脑血管意外史。病程进展缓慢 ,少部分渐发展成肾功能衰竭,多数肾功能常年轻度损害 和尿常规异常。恶性高血压者舒张压需超过120mmHg, 伴有明显心脑合并症且迅速发展,大量蛋白尿,常伴有血 尿,肾功能进行性减退。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 2、肾小管间质病变: 慢性肾小管间质病变常见有慢性肾 盂肾炎、慢性尿酸性肾病、梗阻性肾 病、药物性肾病等。 重点说一下梗阻性肾病。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 梗阻性肾病发病原因 1).小管腔内有沉 积尿酸、磺胺类结 晶、多发性骨髓瘤 轻链。 2).尿路内有结石 、坏死乳头组织和 血块。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 3).尿路壁 (1)输尿管:输尿管-肾盂连接点功能障碍,输尿管- 膀胱连接点功能障碍。 (2)膀胱(神经性): ①先天性有脊髓发育不良。 ②获得性为脊髓痨、糖尿病、脑脊髓多发性硬化、 脊髓外伤、帕金森病和脑血管意外。 (3)膀胱颈功能障碍:实质性病变有肿瘤、感染后肉 芽肿、后和前尿道瓣、输尿管疝、包皮过长、尿 道口狭窄,尿道周围脓疡 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 4).尿路外因素 (1)男性生殖系有良性前列腺增生,前列腺癌。 (2)女性患者有妊娠、子宫肿瘤、子宫颈癌、子宫下垂、子 宫内膜移位、卵巢肿瘤和卵巢脓肿。 (3)消化系有Crohn病,憩室炎,胰腺炎,阑尾脓肿,恶性 肿瘤。 (4)血管系有输尿管-肾盂连接点异位血管,腹主动脉和髂动 脉血管瘤,卵巢静脉血栓形成,腔静脉后输尿管。 (5)后腹膜有炎症,纤维化,手术后并发症,肿瘤(淋巴瘤、 肉瘤),肿瘤转移(子宫颈、大肠、膀胱),盆腔脂肪瘤,出 血等。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 3、肾血管病变 双侧肾动脉狭 窄或闭塞所引起 的“缺血性肾病”, 在老年CRF的病 因中占有较重要 的地位。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 4、遗传性肾病( 如多囊肾、遗传 性肾炎)等。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 在发达国家,糖尿病肾病、高血压 肾小动脉硬化已成为尿毒症的主要病 因,在发展中国家,这两种疾病在尿 毒症各种病因中仍位居原发性肾小球 肾炎之后,但近年也有明显增高趋势 。双侧肾动脉狭窄或闭塞所引起的“缺 血性肾病”,在老年CRF的病因中占有 较重要的地位。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 谢谢大家参 与!! 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 人有了知识,就会具备各种分析能力, 明辨是非的能力。 所以我们要勤恳读书,广泛阅读, 古人说“书中自有黄金屋。 ”通过阅读科技书籍,我们能丰富知识, 培养逻辑思维能力; 通过阅读文学作品,我们能提高文学鉴赏水平, 培养文学情趣; 通过阅读报刊,我们能增长见识,扩大自己的知识面。 有许多书籍还能培养我们的道德情操, 给我们巨大的精神力量, 鼓舞我们前进。 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 谢谢! 湛江中心人民医院湛江中心人民医院 Central people’s hospital of Zhanjiang With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
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